IDSA releases new guidelines for PJI treatment in joint arthroplasty patients

The Infectious Diseases Society of America has released new guidelines to reduce mortality, disability and costs associated with periprosthetic joint infection following total knee and total hip arthroplasty.

“There are few things that improve quality of life as much as joint replacement, but 1% to 2% of the time the new joint can become infected, even when precautions are taken,” Douglas R. Osmon, MD, associate professor of infectious diseases at the Mayo Clinic in Rochester, Minn., stated in a press release. “There are many different ways to treat these infections to achieve the same outcome. The guidelines provide a framework to help multidisciplinary teams choose the best method of diagnosis and treatment for each patient.”

The guidelines recommend the following precautions while performing total joint arthroplasty:

Persistent wound drainage in the skin over the joint replacement is a sign of periprosthetic joint infection (PJI). Sudden or ongoing pain after placing the implant is also a sign if the patient had no previous history of pain, or if there is a history of prior wound healing problems or infections.
In patients with PJI, those patients with a well-fixed implant without an open skin wound could be a likely candidate for debridement by re-opening the incision and cleaning the wound if they had the surgery within the last 30 days.
Patients with a more extensive infection extending to the bone and tissue might need their implant replaced, which can be done during the same surgery or during a later surgery.
Amputation should be a last resort. Prior to amputation, if the infection allows it, the patient should be referred to a center with a PJI specialist.
In almost all cases, a 4- to 6-week intravenous or highly bioavailable oral antiobiotic therapy is necessary to treat PJI.

Reference:

Osmon DR. Clin Infec Dis. 2012;doi: 10.1093/cid/cis803.